Healthcare Provider Details

I. General information

NPI: 1760154157
Provider Name (Legal Business Name): NICHOLAS GITERU MURAGURI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 BELMONT ST
WORCESTER MA
01604-1059
US

IV. Provider business mailing address

62 FAIRVIEW AVE
DUDLEY MA
01571-3485
US

V. Phone/Fax

Practice location:
  • Phone: 508-368-4000
  • Fax:
Mailing address:
  • Phone: 508-410-7161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN2270240
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: